Individual
CHRISTINA CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
7028 COBBLESTONE DR, MEMPHIS, TN 38125-2612
(708) 928-3958
Mailing address
7028 COBBLESTONE DR, MEMPHIS, TN 38125-2612
(708) 928-3958
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000
NON PROFIT
—
05
—
000000
—
TN
Enumeration date
01/04/2019
Last updated
01/04/2019
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